EDGE_TABLE
Monthly aggregation of provider referrals, both explicitly stated on the claim and inferred via patient pathways.
Provider Relationships Reveal Practice Patterns
🤝 Provider relationships are at the core of provider networks, however, the healthcare industry's ability to track and build metrics around the company providers keep is traditionally poor.
🔗 CareQuery® takes great care in defining metrics around provider relationships, what we call "edges."
⛓️ These edges carry nuanced patient journey sensitivities that empower the identification both intentional and unintentional practice patterns and patient movements - over time with incredible detail.
Table Description
| feature | description | example |
|---|---|---|
| year | Year in which the primary encounter occured | 2023 |
| month | Month in which the primary encounter occured | 2 |
| ref_npi | National Provider Identifier (NPI) of the referring provider | 1447546585 |
| ref_name | Full name of the referring provider | kellen benes |
| ref_specialty | Primary specialty of the referring provider | therapy - physical medicine |
| npi | National Provider Identifier (NPI) of the referred provider | 1003221029 |
| name | Full name of the referred provider | gabriel jefferson |
| specialty | Primary specialty of the referred provider | physician assistant |
| inferred | Binary indicator of whether the relationship total was inferred. True indicates that the referral was explicitly stated on the claim False indicates that the referral was inferred from the longitudinal journey of the individual patient. | 1 |
| num_patients | Number of unique patients referred within the explicit or inferred context of the relationship. | 4 |
| num_encounters | Number of unique encounters referred within the explicit or inferred context of the relationship. | 14 |
| total_line_charges | Total line-item provider charges for procedures rendered submitted to insurers by the referred provider (NPI). | 834.18 |
| total_claim_charges | Line-item provider and facility charge for procedures and revenue codes rendered and submitted to insurers. | 1,250.39 |
| total_smart_allowed | Total smart allowed made by the referred provider within the inferred context of the relationship. Smart Allowed is the line-item estimate of allowed amount, utilizing proprietary ML on actual adjudicated amounts to provide estimates, within an average of 5% variance from actuals. | 902.06 |
Updated 9 months ago